Perioral Dermatitis Treatment

Perioral dermatitis is a type of dermatitis (inflammation of the skin). It is most common around the mouth but can also spread to other parts of the body, such as the nose, eyes and, rarely, the genitals.

Perioral dermatitis that occurs in areas other than around the mouth is known as periorificial dermatitis. The condition is not contagious, meaning it cannot be passed from one person to another.

What does perioral dermatitis look like?

Perioral dermatitis appears as a bumpy red rash that may also be dry, scaly, or flaky. The small bumps on the skin contain pus or clear fluid and may itch or burn. Perioral dermatitis is often mistaken for acne.

What causes perioral dermatitis?

The exact cause of perioral dermatitis is not known, but the most common cause appears to be the overuse of a medication called topical corticosteroids. Topical corticosteroids are a type of cream or ointment that is applied to the skin to reduce inflammation. They are commonly used to treat skin conditions such as eczema.

Other possible causes of perioral dermatitis include:

• cosmetics, skin products and facial sun creams
• fluoride toothpaste
• chewing gum
• exposure to strong winds and ultraviolet (UV) light
• hormonal fluctuations
• an overgrowth of bacteria or yeast that live on the skin
• the oral contraceptive pill

Perioral dermatitis is normally treated with antibiotic or anti-inflammatory medications. Antibiotics work by killing bacteria or stopping them from growing and spreading. It is not clear how antibiotics work in treating perioral dermatitis as the condition is not caused by a bacterial infection, but they may work by reducing inflammation. Another ‘off-label’ treatment for perioral dermatitis is pimecrolimus cream (Elidel), which works by reducing skin inflammation such as redness, swelling and itching. Some medications we prescribe for conditions or circumstances that are outside of the licence are also known as ‘off-label’. Prescribing ‘off-label’ is a common practice by healthcare professionals to ensure a medication can safely benefit as many patients as possible. This is always based on updated information and evidence since the product first became available.

How effective is perioral dermatitis treatment?

Treatment for perioral dermatitis is normally effective, though it may take several weeks or months to work. Untreated perioral dermatitis often takes years to clear up and, in some cases, may be permanent.

How long does it take for perioral dermatitis treatment to work?

Antibiotic treatment normally improves symptoms of perioral dermatitis within 6 to 12 weeks. One study found that treatment with pimecrolimus cream improved perioral dermatitis rash within 4 weeks.

Can perioral dermatitis come back after treatment?

Perioral dermatitis may come back after treatment, but this is unlikely if you avoid triggers such as corticosteroid cream.

The first step in treating perioral dermatitis is to stop using whatever caused the condition in the first place. You should stop using any cosmetics or skin care products on your face and wash your face with warm water alone until your skin has healed. You should also avoid using fluoride toothpaste and stop using any over-the-counter treatments that contain corticosteroids. If you are using prescription creams or ointments containing corticosteroids, check with your GP before stopping treatment. Your perioral dermatitis may flare up after you stop using topical corticosteroids, and the condition often gets worse before it gets better after starting treatment.

Medications for perioral dermatitis

Treatment for perioral dermatitis can be topical (applied to the skin) or oral (taken by mouth). Mild perioral dermatitis is usually treated with topical medications and more severe cases with oral antibiotics.

Topical treatments

Topical treatments in the form of gels, creams or ointments are normally applied in a thin layer to clean skin twice a day (morning and evening). Topical treatments used to treat perioral dermatitis include:

• Topical antibiotics such as erythromycin, clindamycin, and metronidazole
• Pimecrolimus cream, Azelaic acid

Oral medications

More severe cases of perioral dermatitis may be treated with a type of antibiotic called a tetracycline antibiotic. You will normally continue treatment for 6 to 12 weeks, and your symptoms should improve within 2 months. Some antibiotics used to treat perioral dermatitis include:

• oxytetracycline —the normal dose of oxytetracycline for perioral dermatitis is 500 mg twice a day. Swallow your tablet or capsule whole with water an hour before food
• lymecycline —treatment with lymecycline for perioral dermatitis is normally 408 mg once a day. Swallow your tablet or capsule whole with water an hour before food
• erythromycin —the usual dose is 500mg twice a day. Swallow your tablet or capsule whole with water with or just before food
• doxycycline —is normally prescribed at a dose of 100mg once a day. You should swallow your tablet whole with water and stay in an upright position (sitting or standing) for at least 30 minutes. You can take doxycycline with or without food.

What’s the best treatment for perioral dermatitis?

The best treatment for perioral dermatitis depends on factors like your general health, what other medications you are taking and the severity of your symptoms. Talk to your GP or dermatologist about which treatment may be best for you.

Like all medications, perioral dermatitis treatments can cause side effects in some people. Most side effects are mild and go away after a few days. If your side effects are bothering you, getting worse or not going away, talk to your GP.

Topical antibiotics

Common side effects of topical antibiotics include:

• stinging
• burning
• itching
• dryness
• redness

Uncommon side effects of topical antibiotics include:

• numbness and tingling in the fingers and toes
• a metallic taste in the mouth
• nausea (feeling sick)

Pimecrolimus cream

Common side effects of pimecrolimus cream include:

• discomfort where the cream is applied

Rare side effects of pimecrolimus cream include:

• itchy rash, swelling of the throat, tongue, eyelids and lips, hives, difficulty breathing and swallowing, and red marks on the hands, feet, and throat (angioedema)

Tetracycline antibiotics

Common side effects of tetracycline antibiotics include:

• nausea
• vomiting
• diarrhoea
• swollen tongue
• black or hairy tongue
• itching of the rectum (back passage) or vagina
• sore throat

Uncommon, but serious side effects of tetracycline antibiotics include:

• headache
• changes to your vision or loss of vision
• swelling of the face, lips, throat, tongue, and eyelids
• raised, red itchy rash (hives)
• difficulty breathing or swallowing
• unusual bleeding or bruising
• joint swelling or stiffness
• chest pain
• watery or bloody stools (poo), stomach cramps, fever

If you experience serious side effects call your GP or 111 immediately.

Rarely, perioral dermatitis treatments can cause a serious allergic reaction called anaphylaxis.

Call an ambulance, or go to A&E immediately if you experience:

• difficulty breathing
• red, raised, itchy rash (hives)
• chest tightness
• swelling of the face, eyelids, tongue, or throat
• dizziness or fainting
• collapse

The above list is not a complete list of possible side effects of tetracycline antibiotics. For a complete list of possible side effects, read the patient information leaflet that came with your medication carefully and ask your GP or pharmacist if you have any questions.

Perioral dermatitis treatment may not be suitable for everyone. Always tell your doctor about any medical conditions or allergies you have and any other medications you are taking before starting treatment for perioral dermatitis.

Topical treatments

Do not use topical antibiotics or pimecrolimus cream if you:

• are allergic to topical antibiotics, pimecrolimus cream or any of their ingredients.

Tetracycline antibiotics

Do not use tetracycline antibiotics if you:

• are allergic to tetracycline antibiotics or any of their ingredients

Tell your doctor before taking tetracycline antibiotics if you:

• have or have ever had lupus or kidney problems
• are pregnant, trying to get pregnant or breastfeeding

Drug interactions

Some medications can interact with each other which can increase side effects, change the way your medications work or make them less effective. Always tell your doctor about any medications you are taking, including over-the-counter medicines, supplements, or vitamins, before starting a new medication.

Some medications that may interact with doxycycline include:

• antacids (used to treat indigestion)
• iron, zinc, or bismuth should not be taken at the same time as doxycycline. Leave 2 to 3 hours between taking these medications and doxycycline.
• carbamazepine, and phenytoin (used to treat epilepsy)
• barbiturates used to treat epilepsy or as a sedative)
• warfarin or coumarins (blood thinners)
• ciclosporin (used to suppress the immune system)
• general anaesthetic (tell your anaesthetist or dentist that you are taking doxycycline if you need to have surgery while taking it)
• alcohol should be avoided while taking doxycycline

Perioral dermatitis needs to be diagnosed by a doctor. If you have symptoms of perioral dermatitis, make an appointment with your GP or dermatologist. This will ensure you get the correct diagnosis and treatment.  Alternatively, you can get an online diagnosis with Superdrug Online Doctor’s skin diagnosis service.  Simply upload a photo of an affected area of your skin, and one of our expert skin doctors will view it and provide a diagnosis, advice, and treatment within 24 hours.

There are no herbal or home remedies that effectively treat perioral dermatitis. If you are diagnosed with the condition, it’s important that you use the correct treatment prescribed by a doctor.  In addition to treatment from your GP, there are some things you can do yourself to improve your perioral dermatitis and prevent outbreaks including: 

• avoid using any creams that contain corticosteroids including over-the-counter treatments 
• avoid using harsh skin care products. Wash your face using only warm water during a flare-up and use only mild, fragrance-free products when your skin has healed
• limit or stop your use of make-up and cosmetics
• avoid using fluoridated toothpaste
• cut down on spicy or salty foods that can irritate the skin around the mouth
• wash pillows and towels frequently on a hot wash 
• stay out of the sun

There is currently no cure for perioral dermatitis, but the condition can normally be treated effectively. Perioral dermatitis can come back, but you can reduce this risk by avoiding triggers such as corticosteroid creams.